I have had PMR for 2 years and in last 4 months have been trying to taper from 10mg down but find constantly bothered by bouts of depression and anxiety and often associated with stress. My cortisol levels are too low to read so my adrenals not working. Is this causing the depression and should I increase the pred.? Or should I ask the doctor for some extra medication?
Boomerang4
Going below 10mg can cause mood problems when the Pred level starts to be less than what you would need of your own natural steroid. If your adrenal glands aren’t working yet, you will feel that lack. Until you are below 5mg it can be the case that you don’t have enough steroid to feel well but the dose is still high enough to make your adrenals think they don’t need to work properly yet. This is shown in your low cortisol reading.
The only way to get things going is by keeping low and reducing very very slowly to avoid having an adrenal crisis. There is no easier way unfortunately. Going back up in dose to feel better just switches back off again any adrenal function you have at all. Personally I found 7-5mg the worst for this as it took being well under 5mg for my adrenal glands to fully get the message. The worst bit of the anxiety and low mood was worrying that I was anxious and had low mood. If it is unbearable, do see your doctor. Otherwise it’s a case of doing what you can to look after yourself in every way, and be patient that it does get better. It can take many months. I reduced by 0.5mg drops introduced over anything from 4-8 weeks at first but then getting slower and slower as I got lower. My slowest was 0.5mg over 14 weeks.
See this re adrenals, which it could well be , and probably best not to increase as SnazzyD has suggested... otherwise the problem might be solved temporarily but will re-occur when you drop back down.
Slow tapering plan, small steps and patience will get you through -
healthunlocked.com/pmrgcauk...
But Pred itself can cause depression in some.. if its really bad then speak to doctor or try some self help with medication, but therapies etc might be enough.
This was written post Covid, but you might find it useful [from the FAQs]-
healthunlocked.com/pmrgcauk...
Thank you Dorset Lady and SnazzyD confirming that increasing the pred. is not the answer. Problems I have had on this journey are stress , over exercise and then the flares. Two days ago had unbearable neck pain and dizziness coinciding with ending of 2 months of horrible stress. Pain killers no good and only way was to increase pred. to 30mg. Other worrying symptoms were dreadful feeling early am and very high B.Pressure 240/130 ! This came down to normal 150/80 by 12 noon when I saw doctor. Now on 20mg , no neck pain but dizziness if move neck suddenly and feel unwell early am. Find it difficult to deal with any form of stress and get angry very easily. The B.P. is still high early am for first hour but goes down after walking dogs. I hope things get better now stress cause now much lessened . Will continue to reduce pred. and have asked doctor if he can help me deal with the depression independently. I guess there are many causes of my depression and not being my normal self is one of them! Thank you very much for allowing me to share my experience and your valuable advice.
The issue you have is twofold. Trying to control your PMR with extra Pred, as apposed to not increasing the Pred so helping the adrenals to nudge into working again. It can be a very difficult situation to find yourself in.
Was that BP before or after the 30mg pred?
Good question. That was before the 30 mgm dose. I have had angina treated successfully with stents. My heart had lots of checks and all OK. I am on prophylactic treatment with Bisoprolol Fumarate. My blood pressure normally goes up quickly under stress so it could be a normal reaction for me when i get a flare. However, i am monitoring it . Thank you.
Anxiety and depression
Psychological effects of prednisolone.
Depression and PMR
Prednisolone and Omeprazole 
Covid and Prednisolone.
